RFP 2025HCA15 Exhibit D Cost Proposal

Description

Exhibit D - Cost Proposal Pricing for Selected Incontinence and Urinary Supplies Monthly Quantity Estimated Limit (PA Required Annual Over Qty Limit) Quantity 2 312 3 Year Initial Contract Term 4 Year Initial Contract Term Total Bid Unit Cost Per Item Amount $0.00 Total Bid Unit Cost Per Item Amount $0.00 5 Year Initial Contract Term Item No. 1 Unit EA HCPC Code* A4310 2 EA A4311 Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating, (Teflon, silicone, silicone elastomer or hydrophilic, etc.) 2 1 $0.00 $0.00 $0.00 Bard 800 Series 3 EA A4312 Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone 2 0 $0.00 $0.00 $0.00 Bard 720000 Series 4 EA A4314 2 8 $0.00 $0.00 $0.00 Bard 802016, Bard 802018 5 EA A4315 Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex w/coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.) Insertion tray with drainage bag, with indwelling catheter, foley type, two-way, all silicone 2 17 $0.00 $0.00 $0.00 Covidien 6900 Series, Covidien 6950, Bard 897214, Bard 897216, Bard 897218. 6 EA A4320 Irrigation tray with bulb or piston syringe, any purpose 30 454 $0.00 $0.00 $0.00 AMSINO AS130 (Bulb), AMSINO AS136 (Piston), Covidien 67803. 7 EA A4322 Irrigation syringe, bulb or piston, each 12 1,561 $0.00 $0.00 $0.00 Amsino AS011 (Bulb), Bard 750379. 8 EA 30 0 $0.00 $0.00 $0.00 $0.00 Item Description Insertion tray without drainage bag and without catheter (accessories only) 9 EA A4326** Male external catheter, specialty type, e.g., inflatable, faceplate, etc.